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Signs
Conjunctival hyperemia Swollen lids Mucoid Discharge
Reduced Vision Cliary injection Constricted pupil Flare in AC Reduced vision Ciliary injections Localised corneal opacification, abrasion or FB
Iritis
Keratitis/Foreign Body/Abrasion
Acute Glaucoma
Unilateral (usually) Lacrimation Photophobia (Pain!) Blurred vision Headache, Halos, Vomiting
Reduced vision Ciliary injection Corneal edema Dilated pupil Raised IOP
Iritis
What might you find on examination of the anterior chamber by slit lamp?
Headlights in the fog Dust in a sunbeam
Doctor, I see flashes of light and a curtain has dropped over my right lower visual field Diagnosis?
Doctor, I cant see well out of my right eye. Its hazy and there are floaters Diagnosis?
FB sensation
A young male presents to the ER with foreign body sensation to this left eye. He was pounding a nail and felt something get into his eye. You examine patient and find that other than some photophobia, his exam is normal. You are about to discharge him when the attending says, hold on just a minute. What could you have possibly missed? How do you make the diagnosis?
Positive Seidels
You carefully examine the patient and place fluorescein in his eye. You see the fluorescein streaming. What is this called? What does it signify?
BLOWOUT FRACTURE
Pathophysiolog y
Signs:
Periorbital subQ emphysema Limitation of EOM Enophthalmos Anesthesia of the ipsilateral cheek and upper lip - WHY? Periorbital ecchymoses/swelling
Blunt Trauma
The patient may also have a hyphema Make sure to look with a slit lamp Some may be microscopic - Blurred vision - Risk of re-bleed, glaucoma
Blunt Trauma
They may also have a subconjunctival hemmorhage or lens dislocation.
Eyelid laceration
A young child presents to the emergency department with a small laceration of her left upper eyelid. What's that protruding from her laceration? What does it signify?